| NPI | 1295010627 |
|---|---|
| Former Name | JENNIFER J. PARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901004914) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 14259) |
| Enumeration Date | 2011-10-17 |
| Last Update Date | 2015-11-05 |